Fraud Advisor

Cigna Group•Saint Louis, MO

About The Position

The Fraud Advisor supports the identification, development, and resolution of fraud, waste, and abuse (FWA) investigations across the healthcare environment. This role applies investigative judgment, data analysis, and collaboration with cross‑functional partners to assess risk, document findings, and support program integrity efforts. Primary Responsibilities Include: Apply advanced professional knowledge to effectively manage complex fraud, waste, and abuse concerns involving prescriber and pharmacy activity on behalf of client needs and expectations, independently and with minimal management oversight. Identify and recommend solutions to improve SIU workflows and address operational weaknesses through process improvement initiatives. Assist with training, case staffing, and End2End review support for new and seasoned investigators on an ongoing basis. Work independently and collaboratively with internal and external business partners to oversee and execute projects and requests responsive to client needs. Collaborate with fraud leadership and cross‑functional partners to identify trends, mitigate emerging risks, and enhance enterprise fraud prevention strategies. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 85,400 - 142,300 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here . About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email [email protected] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Responsibilities

Apply advanced professional knowledge to effectively manage complex fraud, waste, and abuse concerns involving prescriber and pharmacy activity on behalf of client needs and expectations, independently and with minimal management oversight.
Identify and recommend solutions to improve SIU workflows and address operational weaknesses through process improvement initiatives.
Assist with training, case staffing, and End2End review support for new and seasoned investigators on an ongoing basis.
Work independently and collaboratively with internal and external business partners to oversee and execute projects and requests responsive to client needs.
Collaborate with fraud leadership and cross‑functional partners to identify trends, mitigate emerging risks, and enhance enterprise fraud prevention strategies.